Q about a fib and gaps in heart rate

[GoldenFire5]

I am in clinicals on a DOU/stepdown floor, and as students, we go from report to report. For pts in a fib, the gaps in heart rate seem to be an expected piece of info as part of report. Is this significant because it is an indicator of how irregular the ventricular rate is? What kind of gap is expected in a pt with a fib? How long of a gap is a real cause for concern? Thanks. :)

[FireStarterRN, BSN, RN]

Not sure what you mean by 'gaps'. Do you mean the ventricular response? The goal in managing a-fib is 1)Control the ventricular response rate to at least below 100 beats per minute and 2) anti-coagulate

[GoldenFire5]

Yes, the gaps in ventricular response. Both a fib patients I've had so far have had 2 to 3 second gaps... just wondering if this is the norm for a fib.

[FireStarterRN, BSN, RN]

Yes, the gaps in ventricular response. Both a fib patients I've had so far have had 2 to 3 second gaps... just wondering if this is the norm for a fib.

Oh, I'm used to calling those 'pauses'. That patient would be needing a pacemaker. Those are bad.

[heartbeat2]

Sometimes pauses are a result of medication and may need to be adjusted.

If undermedicated, the rate can become quite rapid, overmedicated, very slow. Also, is this a new onset of A-fib or chronic? A-fib has the increased risk of blood clots forming in the atria since they aren't emptying fully. If the patient converts to a sinus rhythm watch for signs of stroke, MI, PE. Hope this helps.:redbeathe

[Dinith88]

Yes, the gaps in ventricular response. Both a fib patients I've had so far have had 2 to 3 second gaps... just wondering if this is the norm for a fib.

3 second pauses that occur frequently would give a patient an effective heart rate of 20's-30's. Thats too low. Like someone said, it may be medication related (many meds given to a-fib slow the heart rate...sometimes too much). If a dosage adjustment fails to correct these 'pauses' (call them 'pauses' and others will know what you mean...rather than 'gaps'), then (again like someone else said) the patient will need a pacemaker.

So...yes...to answer your first question, LONG pauses are significant and should be passed along in report.

[Virgo_RN, BSN, RN]

I'm not sure what you mean by "gap". Do you mean the R to R interval, or pauses? The R to R is irregular with afib, so I'm not sure how you'd get a number. Not everyone in afib has pauses, either.

If someone is in afib and is having pauses, then it typically indicates that the person is overmedicated, and the cardiologist will usually decrease their dosage of whatever med they're on.

I don't typically do backflips over occasional 2-3 second pauses. Usually, once their medication has been adjusted, it takes some time for the blood levels to drop and the frequency and duration of pauses to decrease. If, however, it seems that the pauses are becoming more frequent or longer in duration, then that would be cause for concern. I'll notify the physician and make sure we have atropine readily available (we always do, but it just feels more proactive to double check).

[ivorybunny]

Usually unless the slow ventricular rates are >3.0 they don't get a pacemaker. Each cardiologist is different with what they will say needs a PPM. Because it's an irregular rhythm, it is not a big surprise if a patient has a slow ventricular response. I was taught we don't call them pauses unless they are in sinus.

[GoldenFire5]

Thanks - I really appreciate everyone's responses.

[Dirkje45]

in af the rate of ventricular contraction is less than the rate of atrial contraction. the rate of ventricular contraction in af is determined by the speed of transmission of the atrial electrical discharges through the av node. in people with a normal av node, the rate of ventricular contraction in untreated af usually ranges from 80 to 180 beats/minute; the higher the transmission, the higher the heart rate.

[Southern_RN]

I was taught we don't call them pauses unless they are in sinus.

In a-fib it is "ventricular stand still"-- just sounds more fun :chuckle